Nursing Strategies for Success Chapter 5

Successful Intelligence Two men out hunting

Successful intelligent thinking is BALANCED

Sabiduría Knowledge vs. Wisdom Knowledge: Wisdom Gaining information, understanding concepts Wisdom Collected meaning and significance gained from knowledge Spanish word for the two sides of learning

What is thinking? Asking questions  Move towards answers

Is there such a thing as a “bad question”? Yesterday I was at my local COSTCO buying a large bag of Purina dog chow for my loyal pet, Jake, the Wonder Dog and was in the check-out line when a woman behind me asked if I had a dog.

Is there such a thing as a “bad question”? What did she think I had an elephant? So since I'm retired and have little to do, on impulse I told her that no, I didn't have a dog, I was starting the Purina Diet again. I added that I probably shouldn't, because I ended up in the hospital last time, but that I'd lost 50 pounds before I awakened in an intensive care ward with tubes coming out of most of my orifices and IVs in both arms.

Is there such a thing as a “bad question”? I told her that it was essentially a Perfect Diet and that the way that it works is, to load your pants pockets with Purina Nuggets and simply eat one or two every time you feel hungry. The food is nutritionally complete so it works well and I was going to try it again. (I have to mention here that practically everyone in line was now enthralled with my story.)

Is there such a thing as a “bad question”? Horrified, she asked if I ended up in intensive care, because the dog food poisoned me. I told her no, I stepped off a curb to sniff a poodle and a car hit me. I thought the guy behind her was going to have a heart attack he was laughing so hard.

“Only students who have questions are really thinking and learning” Ask questions that stimulate thought. Ask students – do you believe it?

“The difference between good science and great science is the quality of the questions posed.” ~ William Hunter

You want to get an A in your anatomy class Use questions to analyze: What do I need to memorize this week? What multiple pathway to learning is my strength? Come up with creative ideas: What are different ways to study using my strength? Apply practical solutions What ways can I study my anatomy to memorize the body systems? When will I use these study skills? (Analyze)How bad is my money situation? (Creative) What ways can I earn money? (Practical) How do I get a job on campus? Analyitical: What does it take to be a nurse? Get a nursing degree? What field do I want to work in? Creative:

Know your purpose! What are you trying to accomplish? Are your questions leading you towards that purpose?

Can you get smarter? “As jogging is to the body, thinking is to the brain.” ~ Nob Yoshigahara (puzzle master)

January 5, 2010 Puzzles and Alzheimer's A new study adds to a growing body of evidence that mentally challenging activities like word games, playing cards, reading and writing may delay the rapid memory loss that occurs with Alzheimer’s disease. The study involved 488 people who were in their 70s and 80s. All were free from Alzheimer’s at the start. Each participant filled out questionnaires about how often they participated in six leisure-time activities: reading books, magazines or newspapers, writing, doing crossword puzzles, playing board or card games, participating in group discussions or playing music. “The effect of these activities in late life appears to be independent of education,” Dr. Hall said. “These activities might help maintain brain vitality.” For each activity, those who took part every day of the week were rated at seven points; several days a week was rated at four points; and once-a-week participation was rated at one point. Researchers studied them for about five years, performing regular checks to look for signs of memory loss and other symptoms of Alzheimer’s disease. During that time, 101 developed Alzheimer’s or another form dementia. The findings appeared in Neurology, the medical journal of the American Academy of Neurology. Among those who developed dementia, the more activity points someone had, the longer they went without showing obvious signs of memory loss and other symptoms. The researchers found that for every additional activity a person participated in, the onset of rapid memory loss was delayed by about two months. “The point of accelerated decline was delayed by 1.29 years for the person who participated in 11 activities per week compared to the person who participated in only 4 activities per week,” said study author Charles B. Hall, Ph.D., of Albert Einstein College of Medicine in New York. The results remained valid even after researchers factored in the education level of the participants. Having many years of formal schooling has been shown to reduce the risk of Alzheimer’s in old age. “The effect of these activities in late life appears to be independent of education,” Dr. Hall said. “These activities might help maintain brain vitality.” The findings are consistent with earlier reports that mentally challenging activities may help to build up so-called cognitive reserve, or the ability of the brain to function normally despite showing signs of damage from Alzheimer’s disease. So while participating in these mentally stimulating tasks did not prevent the onset of Alzheimer’s altogether, it did delay the onset of memory loss and thinking problems.

How can You improve your analytical thinking skills? AKA: Critical Thinking Gathering information Analyzing & Clarify Evaluating for the purpose of Gaining understanding Solving a problem Making a decision

Gather information (Define your purpose!) Information How much do you need? How much time do you spend gathering? Is the information relevant? Writing a paper on nursing ethics: Review assignment – what are the requirements - research out relelcant information Choose two topics, find 4-5 comprehensive pieces on each Sick patient: Diagnosis of diabetes Review in mind pathophysiology of diabetes? What might be wrong? Obtain data: -read their chart lab values, medications FSBS Vital signs Assess urine output Assess skin for dryness, color,

Analyze & Clarify information Break information into parts Separate the ideas Compare and Contrast Examine cause and effect* Look for themes, patterns and categories Separate the ideas Paper: ER nurse: different types of ER nurses. Triage. Cardic monitor. Major trauma ICU: CCU, Neonatal ICU(NICU) Telemetry Diabetic patient: Vital signs FSBS Medications

Analyze & Clarify information Examine whether examples support ideas Distinguish fact from opinion Subjective Information Objective Information

Objective information Is observable, able to be seen, heard or touched, smelled, tasted Factual Able to be counted Able to be described The same from multiple reporters is verifiable. Another person can repeat the observation, you can perform some type of test, etc.

Objective language I saw… I counted… I observed… This is what he did… This is what it sounded like…

Subjective information Is opinion, judgment, Assumption, beliefs, rumor or suspicion Varies from person to person, day to day Information that can be interpreted differently by other people is what comes out of the patient or family's mouth.

Subjective language I feel … Example: "I feel hot" is subjective as someone may feel hot to themselves but another might touch them and say "no, you're freezing". As opposed to: "I have a temperature of 101 degrees" - this can be measured with a thermometer and the fact remains the same no matter who is looking at the thermometer.

Diabetes Case Study M.G. is a 58 y/o white female who presents to her primary care physician with a complaint of “tired all the time.” Height:5’4” Weight:212 lbs. It’s been going on for several months, and she doesn’t report any concerns with nighttime sleep. She doesn’t note any new stress or other life changes, and denies depression or anxiety. Alcohol consumption is limited to one to two drinks per week, and she quit smoking over 10 years ago. BP:135/86 Family history is notable for type 2 diabetes in an older sister; her mother had hypothyroidism and “heart disease.” The patient also has high cholesterol that she has been trying to treat with “weight loss and exercise.” She walks about 20 minutes three times weekly when the weather allows. Lung sounds are clear Pulse regular and strong She has been treated for about five years for hypertension with hydrocholorthiazide. No thyromegaly

Analyze & Clarify information Examine whether examples support ideas Distinguish fact from opinion Subjective vs. Objective Examine perspective & Assumptions Bias Prejudices Evaluate information

Assess Analytical Thinking Skills I tend to perform well on objective tests. People say I’m a “thinker”, “brainy”, “studious”. I am not comfortable with gray areas – I prefer information to be laid out in black and white. In a group setting, I like to tackle the details of a problem I sometimes over think things and miss my moment of opportunity. Score 1-5 1=least like me; 5 most like me.

How to Improve your creative thinking skills

Improving creativity Brainstorming Divergent thinking Group think

Improving creativity Shift your perspective Challenge assumptions Take a new and different look Ask “what if” questions

Improving creativity Set the stage for creativity Choose – or create environments that free your mind Be curious Give yourself time to “sit” with a question Believe in yourself as a creative thinker

Improving Creativity Take risks Fly in the face of convention Let mistakes be Okay

Assess creative thinking I tend to resist rules and regulations. People say I’m “expressive,” “full of ideas,” innovative. I break out of my routine and find new experiences In a group setting I like to toss ideas into the ring If you say something too risky, I’m all for it. 5-12 Weak 13-19: average 20-25: strong

Improving practical thinking skills Experience “Experience is the greatest teacher!” Benjamin Franklin (Poor Richard's Almanack, Nov. 1743) offered, "Experience keeps a dear school, yet fools learn in no other.“

The emotional intelligence connections

Practical thinking means action! Stay motivated Make the most of your personal strengths When things go wrong, accept responsibility and reject self pity Focus on the goal and avoid distractions Manage time and tasks effectively Believe in yourself

Assess practical thinking skills I can find a way around any obstacle People say I’m a “doer” and “go-to” person “organized”. When I have a vision, I translate it into steps from A to B to C. In a group setting, I like to set up the plan I don’t like to leave loose ends dangling – I’m a finisher.

How is this type of thinking used in Nursing? NURSING PROCESS!

Overview of the Nursing Process Consists of 5 steps Assessment Diagnosis Planning Implementation Evaluation Build on each other Not linear

Nursing process is dynamic and requires creativity in its application Steps remain the same Application and results different Used throughout the life span in any care setting

Small group questions: How many steps are in the nursing process? What are the names of each of the steps? What is the purpose of the nursing process? In what clinical setting is the nursing process used?

Assessment Step #1 Involves Collecting data (from variety of sources) Validating the data Organizing the data Interpreting the data Documenting the data

Assessment Validating the Data Organizing the Data Interpreting the Data Relevant vs. irrelevant Gaps? Identify patterns Document the Data

Small Group Questions Which of the following are objective data and which are subjective data. A. Nausea B. Vomiting C. Unsteady gait D. Anxiety E. Bruises on the right arms and face F. Temperature 101 F

Diagnosis Step 2 in the nursing process Formulating a nursing diagnosis Analysis and synthesis of data

Nursing diagnosis: “A clinical judgment about individual, family or community responses to actual or potential heal problems / life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

Medical vs. Nursing diagnosis Medical diagnosis Nursing diagnosis Identifies conditions the MD is licensed & qualified to treat Identifies situations the nurse is licensed & qualified to treat

Medical vs. Nursing diagnosis Medical diagnosis Nursing diagnosis Identifies conditions the MD is licensed & qualified to treat Identifies situations the nurse is licensed & qualified to treat Focuses on illness, injury or disease processes Focuses on the clients responses to actual or potential health / life problems

Medical vs. Nursing diagnosis Medical diagnosis Nursing diagnosis Remains constant until a cure is effected Changes as the clients response and/or the health problem changes

Medical vs. Nursing diagnosis Medical diagnosis Nursing diagnosis Remains constant until a cure is effected Changes as the clients response and/or the health problem changes i.e. Breast cancer i.e. Knowledge deficit Powerlessness Grieving, anticipatory Body image disturbance Individual coping, ineffective

Diangosis Nursing diagnosis Medical diagnosis Breathing patterns, ineffective Chronic obstructive pulmonary disease Activity intolerance Cerebrovascular accident Pain Appendectomy Body image disturbance Amputation Body temperature, risk for altered Strep throat

Planning & Outcome identification Step Three: Planning Identifying outcomes Goals An aim, intent or end. Short term goals Hours to days (less than a week) Long term goals Weeks to months

Planning & Outcome identification Developing specific nursing interventions Independent nursing interventions No order needed Elevate edematous legs Interdependent nursing interventions In conjunction with an interdisciplinary team member Assist client with physical therapy exercises Dependent nursing interventions Require an order Administering of medications

Prioritizing the nursing diagnosis Maslow’s hierarchy of needs

Maslow’s Hierarchy of Needs

Implementation DO IT DO IT RIGHT DO IT RIGHT NOW! 4th step: Execution of the nursing care plan Delegation DO IT DO IT RIGHT DO IT RIGHT NOW!

Evaluation 5th step Determining whether the clients goals have been met, partially met or not met.

Solving a problem Define the problem Analyze the problem Solutions Potential positive effects Potential negative effects Practical action Final Evaulation

Decision making thoughts Look at the given options – then try to think of more Think how decision effects others Gather perspectives Look at the long term effects Ethical dilemmas – Keeping your balance

Solving a problem SOAP! Subjective Objective Assessment Plan